Affordable use of indwelling pleural catheters for malignant pleural effusion.

Abstract

Background and objective: Indwelling pleural catheters (IPC) relieve symptoms in malignant pleural effusion (MPE), while maintaining a reasonable quality of life. However, the high cost of the catheter and the drainage bottles limits their use in low- and middle-income countries. The objective of this study was to determine the time to pleurodesis, feasibility and safety while reusing a low-cost adaptor kit for IPC drainage in a retrospective cohort of patients with MPE.

Methods: Consecutive patients undergoing IPC insertion over 5 years at a tertiary cancer center were included. IPCs were preferably inserted on outpatient basis, and drained at home using an adaptor kit and syringe. Talc pleurodesis was offered on lung re-expansion and reduction in drainage. IPC was removed if pleurodesis was achieved, after which follow up was done till 1 year.

Results: The study included 69 patients. Twenty-five (36.2%) patients achieved pleurodesis during follow up after 40 (IQR 30-62) days. Thirteen patients who had undergone talc instillation achieved pleurodesis after 34 (IQR 21-40) days as compared to 46.5 (IQR 40-73.5) days in the 12 patients with spontaneous pleurodesis ( P = 0.06). We recorded 12 (17.4%) severe adverse events. Pleurodesis failure was noted in 2 (11.1%) patients after IPC removal.

Conclusion: IPC was an effective treatment in adults with MPE with an acceptable incidence of adverse events when aspirated using adaptor kit. Studies comparing IPC and intercostal drainage tubes in our setting are needed.